What are the side effects of Xeloda (capecitabine)?

Side Effects of Xeloda (Capecitabine)

Hand-foot syndrome is the most common and characteristic side effect of Xeloda (capecitabine), occurring in up to 73.4% of patients, with grade 3 events in approximately 11.1% of cases. 1

Common Side Effects by Body System

Skin-Related

• Hand-foot syndrome (palmar-plantar erythrodysesthesia):

  • Presents as redness, swelling, numbness, and peeling of the palms and soles
  • Can progress to blistering and severe pain that interferes with daily activities
  • Occurs due to secretion of capecitabine through sweat glands onto skin surface 2
  • Management requires dose interruption or reduction for severe cases

• Other skin reactions:

  • Skin pigmentation
  • Rash
  • Photosensitivity

Gastrointestinal

• Diarrhea:

  • Occurs in many patients, with grade 3-4 severity in up to 14% of patients 1
  • Higher incidence when combined with other agents (up to 47% with CapeIRI regimen) 1
  • May require antidiarrheal medications like loperamide

• Nausea and vomiting

• Stomatitis/mucositis

• Anorexia

• Abdominal pain

Hematologic

• Neutropenia: Less frequent than with IV 5-FU 3
• Anemia
• Thrombocytopenia

Neurological

• Fatigue
• Dizziness
• Headache

Hepatic

• Elevated liver enzymes
• Hyperbilirubinemia

Severity and Management

Hand-Foot Syndrome Management

1. Early recognition of symptoms is crucial
2. Treatment interruption is the most effective management strategy 4
3. Dose reduction may be necessary for severe cases
4. Supportive measures:
   • Emollients and moisturizers
   • Avoiding tight-fitting shoes and excessive pressure on hands/feet
   • Cool compresses

Diarrhea Management

For uncomplicated diarrhea (grade 1-2) 1:

• Oral hydration
• Dietary modifications (eliminate lactose-containing products)
• Loperamide (4 mg initially, then 2 mg every 4 hours or after each loose stool, max 16 mg/day)

For complicated diarrhea (with fever, dehydration, etc.):

• Hospitalization may be required
• IV fluids
• Consider antibiotics
• Octreotide in severe cases

Risk Factors and Special Populations

Elderly Patients

• Higher risk of toxicity, particularly diarrhea
• 30-50% of elderly patients require dose reduction 1
• In patients ≥65 years, a lower starting dose may be needed (1,000 mg/m² twice daily instead of 1,250 mg/m²) 1

Patients with Renal Impairment

• Dose adjustments required for patients with reduced creatinine clearance
• Patients with creatinine clearance <50 mL/min may have increased risk of toxicity 1

Monitoring and Prevention

1. Regular monitoring of complete blood count, liver function, and renal function
2. Patient education about recognizing and reporting side effects early
3. Proactive dose modifications at first signs of significant toxicity
4. Adequate hydration throughout treatment

Important Considerations

• Side effects are generally manageable with proper monitoring and dose adjustments
• Temporary interruptions and dose modifications do not reduce overall efficacy 3
• Hand-foot syndrome, while not life-threatening, can significantly impact quality of life
• Patients should be instructed to contact healthcare providers at the first sign of grade 2 or higher toxicities

The management of Xeloda side effects requires vigilant monitoring and prompt intervention to maintain quality of life while maximizing treatment efficacy.